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April 2011
Report on Activities of "WPA International Mental Health Research Fellowship" at Department of Psychiatry in University of Maryland School of Medicine, Baltimore, MD, USA (Six-months)

I started my World Psychiatry Association (WPA) Fellowship in Department of Psychiatry at University of Maryland Medical School in early October 2010. I am attached to the Division of Services Research (DSR) and the Center on Behavioral Treatment of Schizophrenia (CBTS) under the direction of Dr Lisa Dixon and Dr Alan Bellack. The research in the two centers focuses on the development and evaluation of behavioral treatments and the integration of psychosocial and pharmacological treatments for severe mental illness, and substance abuse in people with serious mental illness. I attended the regular recovery research supervision meetings and the weekly departmental journal club meetings, and observed the relevant protocol assessments and intervention sessions.

I was not included in the IRB protocols of the ongoing studies which initiated in CBTS and DSR before I started the Fellowship, therefore in the first several months of the training I cannot be involved in these studies and use the data directly. Instead, with supervision and support of Dr Lisa Dixon, during this period I have analyzed the data which I have collected in China and Asia previously and wrote five papers. The details are as follows:

First, using the baseline assessments of participants of an ongoing randomized controlled trial testing the efficacy of case management in schizophrenia initiated in 2007, I worked out three papers: (1) Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients; (2) Quality of life in community-dwelling patients with schizophrenia in China; and (3) Cigarette smoking in community-dwelling patients with schizophrenia in China. All these papers have already gone, or will go to international journals soon.

Second, I conducted a secondary analysis of the data of a nationwide, randomized, controlled study of clinically stable schizophrenia patients that explored the optimal length of risperidone maintenance treatment in China and produced one paper: Weight changes and their associations with demographic and clinical characteristics in risperidone maintenance treatment in schizophrenia. This paper has been accepted and published by Pharmacopsychiatry recently.

Third, based on the data of the Research on Asian Psychotropic Prescription Pattern (REAP) project that is an ongoing pharmaco-epidemiological survey on prescription trends for psychotropic drugs in schizophrenia inpatients in Asia, I produced one paper: Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009. It has been submitted to an international journal and is being reviewed.

In addition, in the past six-month training, another five papers I worked out previously have been accepted by international journals, including: (1) Association of insight with socio-demographic and clinical factors, quality of life and cognition in Chinese schizophrenia patients (by Comprehensive Psychiatry); (2) Use of anticholinergic drugs in patients with schizophrenia in Asia from 2001 to 2009 (by Pharmacopsychiatry); (3) Frequency, socio-demographic and clinical correlates of tardive dyskinesia in schizophrenia in Asia: 2001- 2009 (by International Journal of Clinical Pharmacology and Therapeutics); (4) Predictors of relapse in patients with schizophrenia: a prospective, multi-center study (by Social Psychiatry and Psychiatric Epidemiology); and (5) Insight in Chinese schizophrenia patients: A 12-month follow-up (by Journal of Psychiatric and Mental Health Nursing).

After being added to the IRB protocols, I will be more closely involved in the current ongoing studies in CBTS and DSR in the coming six-month training. In addition, I will initiate a new study based on the data of the Nationwide Inpatient Sample (NIS) in the Unite States and write up papers with the help of Dr Lisa Dixon and Dr Eric Slide.

I am very grateful to the World Psychiatry Association and the University of Maryland for this training opportunity. I will further gain new insight and experiences in research knowledge and skills in the remaining training, and then apply them in China in the future.

Yu-Tao Xiang, MD, PhD

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